OPHTE# Q`53 )33( Harnett County Department of Public Health
PERMIT #-'s Operation Permit 22844
New Installation A Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION LOT #
System Installer: Ct_v is �,,aQX�x. nl A Registration #
Basement with plumbing: ❑ Garage rK Number of Bedrooms 3
Type of Water Supply: El Community Public El Well Distance from well , b® feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Reauired: _
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the above captioned property.
Other Aux Septic Tank: 100 ® gallons Pump Tank: gallons
exact length width of depth of
of each ditch Q U feet ditches feet ditches it "ate inches
Authorized State Agent �� ���� Date -7 1 n I I-:;
1,a.- 5, 3033 c